Colistin Use in Critically Ill Burn Patients: Issues of Augmented Renal Clearance and Nephrotoxicity

Abstract

Objective: To analyze the characteristics of augmented renal clearance (ARC) and nephrotoxicity in burn patients treated with colistin in the Emergency Resuscitation Department at Le Huu Trac National Burn Hospital. Subject and method: A retrospective cross-sectional study was conducted using medical records of burn patients hospitalized in the Emergency Resuscitation Department at Le Huu Trac National Burn Hospital from January 2024 to December 2025. Cox proportional hazards regression analysis was performed to identify factors associated with colistin-induced nephrotoxicity. Results: The median age of patients was 39.5 years, with males accounting for 82.9%. Most patients had severe burns (grade III or higher). A loading dose of colistin was administered in 88.1% of patients, with a median maintenance intravenous dose of 9 MIU/day. ARC was observed in 59.6% of patients at least once during hospitalization. Among patients with ARC, treatment response rates were 75% in those receiving >9 MIU/day and 59% in those receiving ≤9 MIU/day. Colistin-associated nephrotoxicity occurred in 31% of patients, with a median onset time of 7.5 days. The probability of nephrotoxicity increased over the duration of colistin therapy. Cox regression analysis identified age (HR = 1.04; 95% CI: 1.01–1.07; p = 0.018) and hypotension (HR = 4.07; 95% CI: 1.60–10.35; p = 0.003) as independent risk factors for nephrotoxicity. Conclusion: A high prevalence of ARC was observed among burn patients receiving colistin. In patients with ARC, colistin doses >9 MIU/day tended to be associated with better treatment response. Age and hypotension were independent risk factors increasing the likelihood of nephrotoxicity.